Compare the feasibility and patient tolerance to either a clear fluid (CF) or low residue diet (LRD) started on postoperative day (POD) 1 after elective colorectal surgery.
Diet advancement after surgery traditionally starts gradually with liquids, on the basis of fears that early solid intake may increase nausea, vomiting, and overall complications. A randomized controlled trial comparing LRD and CF on POD 1 was performed.
111 elective colorectal surgery patients were randomized to CF (n = 57) or LRD (n = 54). The primary end point was vomiting on POD 2. Secondary endpoints included nausea score, days to flatus, length of hospital stay (LOS), and postoperative morbidity.
Patient characteristics, surgical technique, intraoperative characteristics, and postoperative opioid use were similar between study arms. CF versus LRD results were as follows: POD2 vomiting (28% vs 14%; P = 0.09), and significant increase in mean nausea score (4.7 vs 3.5; P = 0.01), days to flatus (4.8 vs 3.7 days; P = 0.04), and LOS (7.0 vs 5.0 days; P = 0.01). LOS remained significantly shorter even after adjusting for significant covariates (laparoscopic technique, surgical site, postoperative comorbidity, stoma, and nasogastric tube) with LRD patients having an adjusted 1.4-day decrease in LOS (P < 0.01). There was no significant difference in postoperative morbidity between study arms. Multivariate analysis of all secondary endpoints confirmed an overall significant improvement in outcomes for LRD vs CF (P < 0.01).
LRD, rather than CF, on POD1 after colorectal surgery is associated with less nausea, faster return of bowel function, and a shorter hospital stay without increasing postoperative morbidity.
A randomized controlled trial comparing clear liquid diet versus low residue diet (LRD) on postoperative day 1 of elective colorectal surgery showed superior outcomes in the LRD arm. LRD arm patients had less nausea, faster time to first flatus, and shorter length of stay without increasing morbidity.
*Division of Colorectal Surgery
†Department of Surgery; and
‡Biostatistics and Bioinformatics Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Reprints: Phillip Fleshner, MD, FACS, FASCRS, Division of Colorectal Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048. E-mail: PFleshner@aol.com.
Disclosure: The authors have no conflict of interest.
Podium presentation at the 134th Annual Meeting of the American Surgical Association, April 11, 2014, Boston, MA.